Clinical Pharmacy
Clinical Pharmacy
Clinical Pharmacy
PRESENTED BY
M.JAGADEESH
11Y01T0012
PHARM-D
INTERN
Health Care System
Composed of physician (including other medical and dental staffs), pharmacist ,
nurse and other paramedics
Load to physician & nurse ; high due to the system of "physicians are all in all in
hospital for the treatment of patient, with the help of nurse."
-Residency programs
The discipline that embodies the application and development (by pharmacist) of
scientific principles of pharmacology, toxicology, therapeutics, and clinical
pharmacokinetics, pharmacoeconomics, pharmacogenomics and other allied
sciences for the care of patients.
(Reference: American college of clinical pharmacy)
History
Until the mid 1960s ; Traditional role.
The development of clinical pharmacy started in USA.
More clinically oriented curriculum were designed with the award of
PharmD degree.
These developments influenced the practice of pharmacy in U.K.,
Initially prescription and drug administration records were introduced followed
by an increasing pharmacy practice in hospital wards. Master degree programs
in clinical pharmacy were introduced for first time in 1976.
Knowledge of
drug therapy
Knowledge of Knowledge of
nondrug therapy the disease
Therapeutic Knowledge of
planning laboratory
skills and diagnostic skills
Patient care
Physical Patient
assessment monitoring
skills skills
Level of Action of Clinical Pharmacists
Clinical pharmacy activities may influence the correct use
of medicines at three different levels:
Before the prescription
During the prescription
and
After the prescription is written.
1. Before the prescription
Clinical trials
Formularies
Drug information
Drug-related policies
2. During the prescription
Counselling activity
The clinical pharmacist pays special attention to the dosage of drugs which
need therapeutic monitoring.
Community pharmacists can also make prescription decisions directly, when over
the counter drugs are counselled.
Medication-related Problems
Untreated indications.
Improper drug selection.
Subtherapeutic dosage.
Medication Failure to receive
Medication Overdosage.
Adverse drug reactions.
Drug interactions.
Medication use without indication.
3. After the prescription
Counselling
Preparation of personalised formulation
Drug use evaluation
Outcome research
Pharmacoeconomic studies
Functions of Clinical Pharmacists
1. Taking the medical history of the patient
2. Patient Education
3. Patient care
5. Drug information
9.Patient counseling
15.Pharmacoeconomics
Clinical pharmacy specialists
Usually requires residency in a specialty area, in addition to a
pharmacy practice residency
-Patients get right care from all the facets (all the drug related problems can
easily be eliminated)
"Every drug is poison, its the dose that differentiate poison or drug the
substance is."
The last person to be involved in health care team with the patient;
Pharmacist, so the system has to rely upon him/her.
The service without clinical pharmacy/clinical
pharmacist
-Due to high load to physicians and other health care professionals,
the quality of patient care will be low
"In developing countries like Nepal; Physicians are incompetent, Nurses are careless,
Pharmacists dont know anything(??), System is corrupted, Public is foolish, Patient load is
high."...Prof Furqan Hashmi
"Medicine is for those who need them, not for those who want them."
"If your medicine is not working it may not be your medicine, it may be you"
Medicines are Dangerous
Pharmaceutical care
A practice in which a practitioner takes responsibility for a
patients drug related needs and holds him or herself accountable
for meeting these needs........ Linda Strand 1997
1.Pharmacist-patient relationship
Collaborative effort between pharmacist & patient
I.Data collection;
Collect, synthesize & interpret relevant information
Patients demographic data: age, sex, race etc.
Pertinent medical information
Medical history (current & past)
Family history
Dietary history
Medication history (prescription, OTC, allergies)
Physical findings (weight, height, B.P)
Lab results (serum drug levels, potassium levels, serum creatinine levels relevant
to drug therapy)
Patient complaints, symptoms & signs
A = Assessment,
The pharmacists evaluation of the findings, including a statement of:
Any additional information needed to best assess the problem to make
recommendation
The severity, priority or urgency of the problem
The short term & long term goals of the intervention proposed
Short term goals: elimination of symptoms , Lowering of BP ,Management of acute
asthma without requiring hospitalization
SOAP Note ;
This is used primarily by physicians,
S=subjective findings
O=objective findings
A=assessment
P=plan
Clinical skills & pharmacists role in
Pharmaceutical Care
Patient assessment
Physical assessment
Barriers to adherence
Psychosocial issues
Prescriptive authority
In designated practice site and positions
Effective drug Will the patient take
Safe drug
therapy the therapy? therapy
Aims of
What does the
Pharmaceutical
patient view as an Care
improved quality of
life?
The same error, even a minor one, can have quite different
consequences in different circumstances.
The System:
Only as safe as its designed to be!
Error Active
Latent Failures
producing
Conditions - Slips&lapses
conditions - Mistakes Accident
Defences
Sources of Error
Prescribing error - selecting the wrong or inappropriate
drug/dose/formulation/duration etc
Communicating those instructions
Prospective review
Administration instructions
Clinical pharmacy
Drug distribution system
Opportunity
For Error
What if we are not there!
Admission medication history
Formulary
Prescribing protocols
Allergy check
Prospective review
Administration instructions
Clinical pharmacy
Drug distribution
system
Opportunity
For Error
Patient Assessment Questions